Diabetes | VOL. 68
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1266-P: Diabetes INSIDE: Improving Population HbA1c Testing and Targets in Primary Care with QI

Publication Date Jun 1, 2019

Abstract

As a participant in the ADA’s Diabetes INSIDE program, a 19-member multidisciplinary QI team identified care quality gaps after reviewing 6 years (1/2010 to 5/2016) of EHR data on 3,136 T2DM outpatients seen by 190 PCPs in an urban academic medical center. The team set goals to increase HbA1c testing frequency (reduce 45% of patients with HbA1c intervals > 6 months) and to reduce HbA1c levels in both the overall population and patients with HbA1c > 9%. Implemented strategies included 1) a provider outreach program of departmental and individualized actionable data reports of HbA1c testing intervals and outcomes, 2) a patient outreach program to address individual timely follow-up care, 3) a patient awareness campaign to improve understanding of following and improving clinical outcomes, 4) improving structured EHR data capture to improve population monitoring, and 5) standardizing workflow across clinics for pre-visit planning, patient outreach, patient education, checking completion of appointment goals, and post-visit follow-up. Eight-years of EHR follow-up data (1/2010 to 5/2018) on 7,798 patients (mean age 61 years, 57% female, 62% black, 97% insured) with 136,004 visits showed target improvements. Population characteristics were stable over time. A department-stratified Cox proportional hazards model controlling for age, gender, race, and HbA1c level showed a statistically signification 20% reduction in HbA1c testing intervals > 6 months (HR = 1.20±0.07). Statistical process control c...

Concepts

American Association Of Clinical Endocrinologists HbA1c Testing Novo Nordisk Asahi Kasei Corporation Statistical Process Control Charts Urban Academic Medical Center QI Interventions T2DM Outpatients Bayer US Sanofi US

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